Provider Demographics
NPI:1184480477
Name:HOGAN, NIKITA
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:TCHULA
Mailing Address - State:MS
Mailing Address - Zip Code:39169-0103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 MAPLE ST
Practice Address - Street 2:
Practice Address - City:TCHULA
Practice Address - State:MS
Practice Address - Zip Code:39169-3762
Practice Address - Country:US
Practice Address - Phone:662-739-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy